Nebraska lawmakers who have fought for years to expand Medicaid coverage under the federal health care law are backing off their effort now that Donald Trump has won the presidential race and Republicans held their majority in Congress.
Trump's victory cast new doubt over the Obama administration's signature law and raised questions about whether expanding Medicaid — a key part of the package — would remain an option for states such as Nebraska that have not yet done so.
Sen. John McCollister of Omaha, who introduced a Medicaid coverage bill this year, said supporters decided not to pursue it when the 2017 session convenes in January.
"It's pretty clear from the election that Congress will be spending a great deal of time on the (Affordable Care Act)," McCollister said. "There's certainly a desire to expand health care coverage to 97,000 Nebraskans, but until we get some clarity from Congress and the president, I don't think it's useful to spend much time on it."
McCollister said he hopes Congress makes changes to keep the law sustainable but doesn't repeal it outright.
Medicaid expansion has been a perennial issue during legislative sessions since 2013 but was repeatedly blocked by conservative lawmakers. Republican Gov. Pete Ricketts vehemently opposed such bills, as did former Gov. Dave Heineman. Both argued Medicaid expansion was unsustainable.
Advocates for Medicaid expansion touted the health care law's benefits and vowed to keep pressing the issue.
James Goddard, a staff attorney for the group Nebraska Appleseed, argued that repealing the entire law isn't a realistic option because it would leave millions of newly insured Americans without coverage. Although it's unclear what the Trump administration and Congress will do, Goddard said he doesn't believe the new federal Medicaid funding will be taken from states.
"It just doesn't make sense on moral or fiscal grounds to leave people out of this coverage," he said.
Even if Democrat Hillary Clinton had won the presidency, conservative senators still would have fought any bill that expanded Medicaid coverage. Next year's Legislature will consist of 32 Republicans, 15 Democrats, one Libertarian and one left-leaning independent.
Support for the proposal doesn't fall neatly on party lines, but many of the GOP newcomers campaigned on their opposition to expanded Medicaid, said Sen. Bill Kintner, a conservative Republican.
"It had very dim prospects next year anyway," said Kintner, of Papillion. "Every year, we've stopped it by a growing margin. When you throw in the uncertainty of President-elect Trump, who ran on getting rid of Obamacare, I just don't think (the law's supporters) want to bang their head against that wall."
Nebraska is one of 19 primarily conservative states that have rejected efforts to expand Medicaid, the health care program for the poor and disabled. Thirty-one states and the District of Columbia have agreed to the expansion.
Nebraska has an estimated 97,000 childless adults who would qualify for coverage if the state expanded Medicaid. Those who are affected have incomes that are too high to qualify for regular Medicaid but too low to receive tax subsidies available through the federal health care exchange.
The coverage gap exists because tax subsidies are only available to people with household incomes between 100 percent and 400 percent of the federal poverty level.
The Affordable Care Act doesn't provide the subsidies for people who make less than that because the law originally required all states to expand Medicaid, which would have covered that population and made the subsidies unnecessary. But in 2012, the U.S. Supreme Court ruled that the federal government can't punish states that don't expand Medicaid.
The decision not to expand Medicaid continues to frustrate those who fall into the coverage gap, including some who left their jobs so they could keep receiving the benefit.
Lynn Redding of Wood River said she would have fallen into the gap if she had stayed at her job at McDonald's because her income would have been too high.
Redding said Medicaid provides "a lifeline" for the 54 medications she takes and the nine specialists she sees for a variety of illnesses and disabilities. The 37-year-old stopped working three years ago and now lives on $600 a month from Social Security.
"If I were to start working, I'd lose everything," she said. "I would just as soon not be called a freeloader. I'd rather work. But I need my health care. If I didn't have it, I'd be in trouble."
